scholarly journals A study of the benefits of vaccine mandates and vaccine passports for SARS-CoV-2

2021 ◽  
Author(s):  
Aaron Prosser ◽  
David L. Streiner
Keyword(s):  
General Population ◽  
Cohort Studies ◽  
Risk Reduction ◽  
Infection Risk ◽  
Transmission Risk ◽  
Baseline Risk ◽  
Severe Illness ◽  
Vaccine Mandates ◽  
Transmission Studies ◽  
Index Cases

Objective: To evaluate the benefits of vaccine mandates and vaccine passports (VMVP) for SARS-CoV-2 by estimating the benefits of vaccination and exclusion of unvaccinated people from different settings. Methods: Quantified the benefits of vaccination using meta-analyses of randomized controlled trials (RCTs), cohort studies, and transmission studies to estimate the relative risk reduction (RRR), absolute risk reduction (ARR), and number needed to vaccinate (NNV) for transmission, infection, and severe illness/hospitalization. Estimated the baseline infection risk and the baseline transmission risks for different settings. Quantified the benefits of exclusion using these data to estimate the number of unvaccinated people needed to exclude (NNE) to prevent one transmission in different settings. Modelled how the benefits of vaccination and exclusion change as a function of baseline infection risk. Studies were identified from recent systematic reviews and a search of MEDLINE, MEDLINE In-Process, Embase, Global Health, and Google Scholar. Results: Data on infection and severe illness/hospitalization were obtained from 10 RCTs and 19 cohort studies of SARS-CoV-2 vaccines, totalling 5,575,049 vaccinated and 4,341,745 unvaccinated participants. Data from 7 transmission studies were obtained, totalling 557,020 index cases, 49,328 contacts of vaccinated index cases, and 1,294,372 contacts of unvaccinated index cases. The estimated baseline infection risk in the general population is 3.04%. The estimated breakthrough infection risk in the vaccinated population is 0.57%. Vaccines are very effective at reducing the risk of infection (RRR=88%, ARR=2.59%, NNV=39) and severe illness/hospitalization (RRR=89%, ARR=0.15%, NNV=676) in the general population. While the latter effect is small, vaccines nearly eliminate the baseline risk of severe illness/hospitalization (0.16%). Among an infected persons closest contacts (primarily household members), vaccines reduce transmission risk (RRR=41%, ARR=11.04%, NNV=9). In the general population, the effect of vaccines on transmission risk is likely very small for most settings and baseline infection risks (NNVs ≥ 1,000). Infected vaccinated people have a nontrivial transmission risk for their closest contacts (14.35%), but it is less than unvaccinated people (23.91%). The transmission risk reduction gained by excluding unvaccinated people is very small for most settings: healthcare (NNE=4,699), work/study places (NNE=2,193), meals/gatherings (NNE=531), public places (NNE=1,731), daily conversation (NNE=587), and transportation (NNE=4,699). Exclusion starts showing benefits on transmission risk for some settings when the baseline infection risk is between 10% to 20%. Conclusions: The benefits of VMVP are clear: the coercive element to these policies will likely lead to increased vaccination levels. Our study shows that higher vaccination levels will drive infections lower and almost eliminate severe illness/hospitalization from the general population. This will substantially lower the burden on healthcare systems. The benefits of exclusion are less clear. The NNEs suggest that hundreds, and even thousands, of unvaccinated people may need to be excluded from various settings to prevent one SARS-CoV-2 transmission from unvaccinated people. Therefore, consideration of the costs of exclusion is warranted, including staffing shortages from losing unvaccinated healthcare workers, unemployment/unemployability, financial hardship for unvaccinated people, and the creation of a class of citizens who are not allowed to fully participate in many areas of society. Registration: This study is not registered. Funding: This study received no grant from any funding agency, commercial, or not-for-profit sectors. It has also received no support of any kind from any individual or organization.

scholarly journals Evaluating the number of unvaccinated people needed to exclude to prevent SARS-CoV-2 transmissions

2021 ◽  
Author(s):  
Aaron Prosser ◽  
Bartosz Helfer ◽  
David L. Streiner
Keyword(s):  
Decision Support ◽  
Primary Prevention ◽  
Significant Risk ◽  
Infection Risk ◽  
Transmission Risk ◽  
Severe Illness ◽  
Number Needed To Treat ◽  
Transmission Event ◽  
Competing Interests ◽  
Link Type

AbstractBackgroundVaccine mandates and vaccine passports (VMVP) for SARS-CoV-2 are thought to be a path out of the pandemic by increasing vaccination through coercion and excluding unvaccinated people from different settings because they are viewed as being at significant risk of transmitting SARS-CoV-2. While variants and waning efficacy are relevant, SARS-CoV-2 vaccines reduce the risk of infection, transmission, and severe illness/hospitalization in adults. Thus, higher vaccination levels are beneficial by reducing healthcare system pressures and societal fear. However, the benefits of excluding unvaccinated people are unknown.MethodsA method to evaluate the benefits of excluding unvaccinated people to reduce transmissions is described, called the number needed to exclude (NNE). The NNE is analogous to the number needed to treat (NNT=1/ARR), except the absolute risk reduction (ARR) is the baseline transmission risk in the population for a setting (e.g., healthcare). The rationale for the NNE is that exclusion removes all unvaccinated people from a setting, such that the ARR is the baseline transmission risk for that type of setting, which depends on the secondary attack rate (SAR) typically observed in that type of setting and the baseline infection risk in the population. The NNE is the number of unvaccinated people who need to be excluded from a setting to prevent one transmission event from unvaccinated people in that type of setting. The NNE accounts for the transmissibility of the currently dominant Delta (B.1.617.2) variant to estimate the minimum NNE in six types of settings: households, social gatherings, casual close contacts, work/study places, healthcare, and travel/transportation. The NNE can account for future potentially dominant variants (e.g., Omicron, B.1.1.529). To assist societies and policymakers in their decision-making about VMVP, the NNEs were calculated using the current (mid-to-end November 2021) baseline infection risk in many countries.FindingsThe NNEs suggest that at least 1,000 unvaccinated people likely need to be excluded to prevent one SARS-CoV-2 transmission event in most types of settings for many jurisdictions, notably Australia, California, Canada, China, France, Israel, and others. The NNEs of almost every jurisdiction examined are well within the range of the NNTs of acetylsalicylic acid (ASA) in primary prevention of cardiovascular disease (CVD) (≥ 250 to 333). This is important since ASA is not recommended for primary prevention of CVD because the harms outweigh the benefits. Similarly, the harms of exclusion may outweigh the benefits. These findings depend on the accuracy of the model assumptions and the baseline infection risk estimates.ConclusionsVaccines are beneficial, but the high NNEs suggest that excluding unvaccinated people has negligible benefits for reducing transmissions in many jurisdictions across the globe. This is because unvaccinated people are likely not at significant risk – in absolute terms – of transmitting SARS-CoV-2 to others in most types of settings since current baseline transmission risks are negligible. Consideration of the harms of exclusion is urgently needed, including staffing shortages from losing unvaccinated healthcare workers, unemployment/unemployability, financial hardship for unvaccinated people, and the creation of a class of citizens who are not allowed to fully participate in many areas of society.RegistrationCRD42021292263FundingThis study received no grant from any funding agency, commercial, or not-for-profit sectors. It has also received no support of any kind from any individual or organization. BH is supported by a personal research grant from the University of Wroclaw within the “Excellence Initiative – Research University” framework and by a scholarship from the Polish Ministry of Education and Science. None of these institutions were involved in this research and did not fund it directly.Competing interestsThe authors have no competing interests to declare.Ethical approvalNot applicable. All the work herein was performed using publicly available data.Data reportingThe data used in this work are available at https://tinyurl.com/4m8mm4jh and https://decision-support-tools.com/.

Cancer in agricultural populations

2020 ◽  
pp. 837-837
Author(s):  
K. . Togawa
Keyword(s):  
Risk Factors ◽  
General Population ◽  
Cohort Studies ◽  
Health Effects ◽  
Cancer Incidence ◽  
Lower Prevalence ◽  
International Consortium ◽  
Adverse Health Effects ◽  
Specific Cancer ◽  
Cancer Types

Agricultural workers can be exposed to a wide variety of agents (e.g. pesticides), some of which may have adverse health effects, such as cancer. To study the health effects of agricultural exposures, an international consortium of agricultural cohort studies, AGRICOH, was established. The present analysis compared cancer incidence between the AGRICOH cohorts and the general population and found lower overall cancer incidence in the AGRICOH cohorts, with some variation across cohorts for specific cancer types. The observed lower cancer incidence may be due to healthy worker bias or lower prevalence of risk factors in the agricultural populations. Further analysis is underway.

Hypertension and Prehypertension and Prediction of Development of Decreased Estimated GFR in the General Population: A Meta-analysis of Cohort Studies

2016 ◽  
Vol 67 (1) ◽  
pp. 89-97 ◽  
Author(s):  
Carlo Garofalo ◽  
Silvio Borrelli ◽  
Mario Pacilio ◽  
Roberto Minutolo ◽  
Paolo Chiodini ◽  
...  
Keyword(s):  
General Population ◽  
Cohort Studies ◽  
Meta Analysis ◽  
Estimated Gfr

scholarly journals Increasing knowledge on dementia risk reduction in the general population: Results of a public awareness campaign

2021 ◽  
Vol 147 ◽  
pp. 106522
Author(s):  
Stephanie Van Asbroeck ◽  
Martin P.J. van Boxtel ◽  
Jan Steyaert ◽  
Sebastian Köhler ◽  
Irene Heger ◽  
...  
Keyword(s):  
General Population ◽  
Risk Reduction ◽  
Public Awareness ◽  
Awareness Campaign ◽  
Public Awareness Campaign ◽  
Dementia Risk ◽  
Increasing Knowledge

Neurological Anomalies in XYY Males

1972 ◽  
Vol 120 (557) ◽  
pp. 447-448 ◽  
Author(s):  
M. J. G. Harrison ◽  
T. G. Tennent
Keyword(s):  
General Population ◽  
Emotional Disturbances ◽  
Neurological Deficits ◽  
Previous Survey ◽  
Anticonvulsant Medication ◽  
Eeg Abnormalities ◽  
High Incidence ◽  
Initial Hypothesis ◽  
Special Hospitals ◽  
Index Cases

A high incidence of men with the 47 XYY karyotype has been repeatedly demonstrated amongst inmates of prisons (Bartlett et al., 1968; Griffiths et al., 1967) and institutions of psychologically abnormal offenders (Jacobs et al., 1968; Casey et al., 1968). Although genetic surveys of the newborn suggest that there must be many more males with this karyotype who remain undetected in the general population, the high incidence of this karyotype amongst these highly selected groups remains unexplained. The initial hypothesis that the extra Y chromosome was associated with aggressiveness no longer appears tenable, at least in its extreme form, as studies indicate that men with this karyotype are less aggressive than other men in the same institution (Price and Whatmore, 1967). It has also been suggested (Hunter, 1966) that because of their increased stature they are more likely to be seen as aggressive and dangerous, and that emotional disturbances arise from problems consequent to being tall. Forssman and Hambert (1969) have suggested that some cerebral abnormality might account for the behaviour of these individuals, and point to reports of EEG abnormalities as being in keeping with this. In support of this idea, Daly (1969) has reported finding neurological abnormalities in 10 out of 12 XYY males that he examined. He further suggested that neurological deficits might prove valuable in identifying individuals of this karyotype. Criticism has been made of such conclusions (Kessler and Moos, 1970) on the grounds that all such studies have been carried out on patients in special institutions, and that the prevalence of similar abnormalities in the rest of these populations is not known. The following report describes neurological findings in 23 XYY men and in a group of patients with a 46 XY karyotype from the same institution, matched in respect of age (6 months), intelligence (15 points on WAIS), and length of stay (within two years). All patients were from Rampton and Moss Side Hospitals (two of the English Special Hospitals) and had been karyotyped in a previous survey (see Casey, 1971). Apart from those on anticonvulsant medication, all patients had been off drugs for at least the preceding four weeks. Controls and index cases were seen in a randomized order by one of us (M.J.G.H.) who did not know at the time of examination to which group the patient belonged. The neurological anomalies detected in the two groups are shown in the table below.

scholarly journals Contrasting SARS-CoV-2 epidemics in Singapore: Cohort studies in migrant workers and the general population

2021 ◽  
Author(s):  
Hannah E Clapham ◽  
Wan Ni Chia ◽  
Linda Wei Lin Tan ◽  
Vishakha Kumar ◽  
Jane M Lim ◽  
...  
Keyword(s):  
General Population ◽  
Cohort Studies ◽  
Migrant Workers ◽  
Large Scale ◽  
Migrant Worker ◽  
Community Dwelling ◽  
Control Measures ◽  
Preparedness Planning ◽  
Community Transmission

Abstract From January 2020, Singapore implemented comprehensive measures to suppress SARS-CoV-2. Community transmission has been limited, although explosive outbreaks have occurred in migrant worker dormitories. We conducted longitudinal SARS-CoV-2 serology studies among 478 residents of a SARS-CoV-2 affected migrant worker dormitory between May and July 2020, and 937 community-dwelling adult Singapore residents with sera collected before September 2019 and in November/December 2020. By end 2020, <2 per 1000 (0.16%, 95% CrI: 0.008% - 0.72%) adult residents in the community were infected with SARS-CoV-2, approximately 4 times higher than the national notified case incidence. In contrast, in the migrant worker cohort, nearly two-thirds 63.8% (95% CrI: 57.9% - 70.3%) had been infected by July 2020; no symptoms were reported in >90% of these infections. SARS-CoV-2 suppression is feasible with rapid implementation of comprehensive control measures. However, the risk of large-scale epidemics in densely-populated environments requires specific consideration in preparedness planning.

scholarly journals Should preoperative showering or cleansing with chlorhexidine gluconate (CHG) be part of the surgical care bundle to prevent surgical site infection?

2017 ◽  
Vol 18 (6) ◽  
pp. 311-314 ◽  
Author(s):  
Charles E Edmiston ◽  
David Leaper
Keyword(s):  
Surgical Site Infection ◽  
Risk Reduction ◽  
Low Cost ◽  
Surgical Care ◽  
Infection Risk ◽  
Chlorhexidine Gluconate ◽  
Low Risk ◽  
Care Bundle ◽  
Site Infection ◽  
Methodological Issues

Showering preoperatively with chlorhexidine gluconate is an issue that continues to promote debate; however, many studies demonstrate evidence of surgical site infection risk reduction. Methodological issues have been present in many of the studies used to compile guidelines and there has been a lack of standardisation of processes for application of the active agents in papers pre-2009. This review and commentary paper highlights the potential for enhancing compliance with this low-risk and low-cost intervention and provides some guidance for enhancing implementation of preoperative showering with both chlorhexidine in solution and impregnated wipes.

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